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Aim. To compare US, Russian and Indian primary care physicians attitudes, comfort and experiences providing palliative care. Design. Cross sectional survey. Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India. Participants. Primary care physicians. Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores. Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p 0.001. Patient should be informed (US vs Russia vs India) of terminal illness Always (74% vs 31% vs 33%) p 0.001, If Asked (9% vs 64% vs 12%) p 0.001 or Physicians Judgement (15%, 5%, 54%) p 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care Often or Always (63% vs 36% Russian v 21% Indian) p 0.001. Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

The Department of Family Medicine of University of Iowa has a long and collaborative relationship with the Department of Family Medicine of North-Western State Medical University named after I.I. Mechnikov that started over 20 years ago. Relationships like these are very valuable for resident education and continued professional development. In October, 2016 3 attending physicians and 1 resident (the author of this article) were able to visit St. Petersburg to participate in a conference and visit the department. I stayed for an additional two weeks as part of my residency training to participate in clinical, academic and research activities. Below is an outline of the educational and training requirements for doctors of family medicine in the US, comments on the conference, a brief summary of a new research project with investigators from both sites and other details of my experience in Russia.